Desistance from self-harm
Following up her rapid evidence assessment into Self-harm by adult men in prison, Laura Pope, this time with Flora Fitzalan Howard, has just (11 April 2019) published the findings from a small scale HMPPS qualitative study of the experience of men who have desisted from self-harm in prison.
The research was obviously commissioned because of concerns over the rapidly rising levels of self-harm in prison with the aim of understanding the experiences of people who have successfully learned to cope differently and refrain from harming themselves can helpfully inform methods or strategies to tackle this problem. This small-scale, in-depth qualitative study asked how men in prison, who have previously self-harmed but do so no longer, describe the experience of learning to manage their self-harming? What helped or hindered the change process? What is their desistance story?
The researchers interviewed eight adult men in prison with a history of harming themselves, but who had reported desisting from self-harm for more than six months prior to taking part in the research. Their in-depth accounts were analysed using Interpretative Phenomenological Analysis (IPA) to shed light on how they had managed to successfully cope differently. IPA is an in-depth, qualitative methodology used to understand personal meaning, lived experience and how individuals make sense of their world. IPA provides a very rich and detailed understanding from a particular perspective, and is especially useful for shedding light on under-researched phenomena, such as self-harming in prison.
The participants’ accounts revealed the following features to be critical to their desistance story:
- Feeling as though they matter and are cared for by the people around them and the processes that are used to help them,
- Being focused on, and having hope for, their futures and making sense of self-harm in a way that promotes change,
- Developing trusting relationships with others, and trusting that genuine care and help is available,
- Having an accurate understanding of the complex reasons for their harming, and prison staff having a good understanding of these reasons so they can respond effectively,
- Developing a range of strategies to cope that match the range of reasons for people harming themselves, and
- Critical turning points or triggers for change, comprising personal moments of change, individual staff members or specialist units, that enable people to feel safe, believed in and supported.
In practice, these features identified as helping men to desist from harming themselves may be mostly realised through the relationships between prison staff and the people in their care. Programmes of work in Her Majesty’s Prison and Probation Service (HMPPS) that aim to improve meaningful relationships and contact between staff and prisoners, such as Five Minute Intervention (FMI) training, the Offender Management in Custody (OMiC) model, and the drive to develop rehabilitative culture in prison, may particularly lend themselves to ensuring these features are present, and contribute to an effective whole-prison strategy to address self-harm.
The findings imply that staff need to have a more informed understanding of why people harm themselves (combatting the myths that exist about this), what strategies can help them, and implement an individualised and compassionate response to people, including high quality implementation of the processes designed to minimise the risk of self-harm in prisons. Participants identified, for example, further staff training and greater consideration to when and how the Assessment Care in Custody and Teamwork (ACCT) process is applied, and by whom, as important to their success. (See here for new research into ACCT.)
The findings of this study suggest there might be value in considering the potential untapped resource that men who have learned to cope differently provide, and what benefits their involvement in providing care to this group could bring. This has yet to be properly tested. Any promotion and facilitation of support provision by this group would need to be part of a structured scheme which is planned, implemented, monitored and evaluated properly, and carefully considers the particular vulnerabilities of both the givers and receivers of support in this case.
Thanks to Andy Aitchison for kind permission to use the images in this post. You can see Andy’s work here.